MONDAY, March 4, 2002 (HealthDayNews) -- Too little of a good thing can be deadly.
German researchers say stopping cholesterol-lowering drug therapy for people hospitalized with chest pain significantly raises their short-term risk of heart attacks and death.
While it's not clear why doctors would suspend the drugs, called statins, the results of those decisions were stark. The new study found people with artery disease who stopped taking statins when hospitalized for chest pain were roughly three times as likely as those who stayed on the drugs to suffer additional, and sometimes fatal, heart problems over the next few weeks. The research appears in the March 26 issue of Circulation, but was released early.
The study "supports the fact that the statins have actions beyond their beneficial effect on [blood fat] lowering," says Dr. Sidney Smith, chief science officer for the American Heart Association and a professor of medicine at the University of North Carolina in Chapel Hill. "It further emphasizes the importance of statin therapy in the treatment of patients with coronary disease, and also points toward their role in inhibiting the inflammatory response in patients with acute coronary syndromes."
Although Smith says statins are widely underused in the United States, he believes few doctors in this country would stop prescribing the drugs to sick people already taking them.
"If anything, the trend is toward earlier use and much more aggressive use in patients with identified coronary artery disease," Smith says.
Heart disease claims about 450,000 lives a year in this country, and the combination of heart disease and other cardiovascular conditions like stroke account for 950,000 deaths annually, according to the Centers for Disease Control and Prevention (CDC).
Dr. Christian Hamm, of the Kerckhoff Heart Center, and his colleagues followed 1,616 men and women with coronary artery disease that had come to the hospital with unstable chest pain, or angina. Of those, 1,151 had never been on statins, 379 had been taking the drugs for six months and continued to do so, and 86 stopped the medication after being hospitalized.
Over the next 30 days, patients who stayed on the cholesterol drugs were half as likely as those who'd never used them to suffer a heart attack or die, even after adjusting for factors like age, cholesterol levels and the severity of their disease.
The results were worse for those who'd used the pills but stopped taking them. Their risk of heart-related complications and death was nearly triple that of the patients who continued receiving statin therapy, the researchers found. They were also much more likely to undergo procedures to improve blood flow to their coronary arteries within a week of being hospitalized.
Why doctors at the hospital might have halted statin treatment is a mystery, the German scientists say. They might have decided that the drugs weren't working, or simply have forgotten to continue the prescription.
"Pretreatment with statins before onset of symptoms significantly reduced cardiac events during the first days after onset of symptoms," the study states. Stopping therapy when chest pain became severe "completely abrogated its beneficial effect. Thus, withdrawal of statin therapy in unstable patients should be avoided."
Kenneth Walsh, a statin expert at Boston University, says evidence in animals and people shows the drugs appear to have both long- and short-term benefits on vessels.
"There is quite a bit of work out there to indicate that statins' effects are beneficial well before they seem to have their effects on lowering cholesterol levels," says Walsh, adding that early on the compounds likely activate chemicals that promote heart health.
What To Do: To learn more about high cholesterol and how to keep it in check, visit the American Heart Association. You can also try HeartInfo or the CDC to get more information about heart disease.
